Written by Courtney Human RD(SA) 01/08/2023

Moving on from the dairy debate last month, there is a non-dairy gap which needed to be filled for those who ethically, medically, or simply personally choose to opt for cow’s milk alternatives. For me at least, this initially thought-of trend hit me like a tonne of bricks with dairy defence mode being triggered. But later I realized getting in touch with these milk alternatives was the only way forward as a registered dietitian and my job was to help people make science-based informed decisions about their daily cuppa.

Just to clarify a milk alternative is a made from nuts, seeds, grains, or legumes with the end product having a milky-white colour just like dairy milk, being used in the kitchen just like dairy milk, possibly fortified with vitamins and minerals to try be just like dairy milk. BUT does not have the nutrient composition just like dairy milk, hence in layman terms a milk alternative is a ‘dairy milk wannabe.’

Typically, I assumed those choosing the dairy free life are lactose or milk protein intolerant, have a milk allergy, are vegan or have a family member that’s vegan pressuring them to save the planet too. But when asking the alternative milkers, I realized in most cases people (not in the above categories) simply jumped on the band wagon of assuming veganism is healthier hence the same must apply with dairy free milk. Alternatively, people switched- just for just- with the misconception that a milk alternative has the same nutrient composition as cow’s milk. However, not only is the composition of cow’s milk different to milk alternatives, but each milk alternative is different from each other too. Hence, this explains why for dietitians moving towards a dairy free life is a ´nutritional red flag’ as your milk alternative could potentially be creating a nutrient gap in your diet!

So, I made this visual to help us compare. We can see that soy milk has a nutrient profile most similar to cow’s milk. Most brands are fortified with calcium but not always fortified with vitamin D which aids in calcium absorption thus try aim for selecting a brand that contains both to promote optimal bone health. Unlike cow’s milk, soy milk offers around 2 grams of fibre per cup as a bonus. But, of course, the dietitian’s choice in terms of highest nutrient density has a questionable taste – murphy’s law.

Oat milk sits on the opposite spectrum in terms of flavour with its richness and creaminess. Since it’s made from a grain, it is higher in carbohydrates with 15-20 grams per cup, however, contains significantly less protein than cow’s milk. Oat milk is a higher fat option and more calorie dense. Moreover, the fat in oat milk usually comes from sunflower or canola oil rich in omega 6. Omega 6 in excess can promote inflammation since these fatty acids are already very prevalent across our food supply unlike omega 3, which is anti-inflammatory. Oat milk is also higher in fibre than other milk alternatives containing beta-glucans, a type of prebiotic fibre that feeds our good gut bacteria amongst other health benefits.

Rice milk from a nutritional standpoint is very low in protein, vitamins, and minerals, and not all brands are fortified. Although rice milk is one of the least allergenic milk alternatives available it is also one of the highest in carbohydrates, thus it may not be the best choice for diabetics. Similarly, to oat milk, the fat in rice milk comes from seed oils but rice milk does contain less fat– at least it has something going for it. In alignment with rice milk is coconut milk which also contains the lowest protein levels whilst being the highest in fat, carbohydrates, and energy – a calorie deficit may be difficult to reach.

Most nut-based milks have similar nutrient profiles but we going to focus on almond milk. Almond milk is rich in vitamin E, an antioxidant that’s beneficial for eye and skin health and often contains 50% more calcium than dairy milk thanks to fortification processes. This is a fan favourite as generally almond milk is the lowest in kilojoules of all milks and poses a nice option for those looking to lose weight, as well as those trying to boost their calcium intake. But, if you’re looking for a protein-rich option, almond milk alone is still not ideal.

Overall, when using a milk alternative as a complete dairy substitute we may need to ensure adequate protein or calcium in the diet by means of other non-dairy additions. For example, without fortification you may have to find you calcium from other food sources e.g., sardines. Alternatively, you may have to add a whey or pea protein powder (2 teaspoons per serving) to make sure you meet your protein goal. Hence, choosing a milk alternative needs to be an informed decision.

It starts with the first question of why you are choosing a milk alternative. Decide if it is a dietary restriction, taste preference, a new trend you are following, you feel healthier, want to help save the planet etc. Having a reason is more important than what the reason is. Secondly, consider the nutritional composition. Some may want a milk alternative with a nutrient profile most similar to cow’s milk in order to help meet their calcium, protein, vitamin A and vitamin D needs.  If you are using it as a diary substitute and it’s your protein of your meal, then there actually needs to be protein in it. Others may be looking to manage their blood sugar or lose weight; therefore, they will want to select the option lowest in carbohydrates or calories and that’s fine too. It all about what you want out of your milk alternative. Finally, cross check what you think you are getting and what is on the product label. Label reading is essential to see whether fortified with cow’s milk nutrients, as all brands differ.

The only sound advice a dietitian may give is going for the unsweetened milk alterative or non-barista blend to avoid unnecessary added sugars. But then again, if you’re just adding a splash to your morning coffee, a little added sugar won’t make or break your health anyway. Similarly, to the diary debate conclusion there is no right or wrong answer when it comes to cow’s milk alternatives either, as it is all relative to your specific dietary needs, health goals and lifestyle. You just need to know the “why” and we as dietitians can help you figure out the “how” to ensure your nutritional goals are reached no matter what milk is filling your daily cuppa.